Participant Info Participants Name* First Last Mailing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*CellEmail Age*Date of Birth* Gender*MaleFemaleWeight*School/EmployerParent/ Legal Guardian Name(s)* First Last Emergency Contact Information*Overview: Boxing program will teach physical conditioning, endurance drills and basic boxing skills.Participation & Fees*Session 1: Sept. 1-Oct. 29 , Tues/Wed/Thurs - $85.00/MonthSession 2: Nov. 1-Dec. 31 , Tues/Wed/Thurs - $85.00/MonthSession 3: Jan. 5-Feb. 25 , Tues/Wed/Thurs - $85.00/Month$35.00 annual registration fee$85.00 per month for each member In addition to monthly fees, all Alaska Boxing Academy members must register with USA Boxing for the athlete membership - $75.00 annually. Registration must be verified within 30 days of joining ABA, or as otherwise stated by administrators.*Days and times may change slightly; notice will be given if there are foreseeable changes to the schedule. NO REFUNDS WILL BE GRANTED — MEMBERSHIP IS NON-TRANSFERABLEI, the participant or parent/legal guardian, agree that I or my child, voluntarily participate in the Alaska Boxing Academy (ABA) activities and use of facilities and premises, and assume all the risk of injury, or the contraction of any illness, or medical condition that might result. I agree on behalf of myself (parent/legal guardian, personal representatives, heirs, executors, administrators, agents and assigns) to hold harmless ABA from any occurrence as result of action, (known or unknown) arising through participation in the ABA program. This waiver and release of liability includes, without limitation, injuries which may occur as result of: (a.) Use of any exercise equipment which my malfunction or break (b.) Improper maintenance of any exercise equipment or facilities (c.) Negligent instruction or supervision (d.) Participant slipping or falling while in an exercise session or on premises I acknowledge that I have carefully read this Waiver and Release and fully understand that it is a release of liability. I am waiving any right that I may have to bring a legal action to assert a claim against ABA.Participant Signature*Parent/Legal Guardian Signature*Date* Pay now via PayPal?*YesNoSelected session first month and registration total:* Price: $85.00 EmailThis field is for validation purposes and should be left unchanged.